Written by: Kristen DiFilippo, PhD, RDN
The Mediterranean diet has long been recognized as a positive dietary pattern for supporting overall health. The Mediterranean diet includes following a dietary pattern that is based in fruits, vegetables, and whole grains; incorporates healthy fats such as olive oil; focuses on small amounts of protein with a focus on seafood; includes moderate intake of wine; and limits processed foods, sweets, and red meat.
High adherence to the Mediterranean diet is associated with improved physical fitness (Bizzozero-Peroni, et al., 2022). Additionally, adhering to this diet is linked to reduced overall mortality (Lanford, et al., 2023).
Obstacles to Adherence
Despite these benefits, adherence to the Mediterranean diet is declining (Damigou et al., 2023), even in the Mediterranean basin (Obeid, et al., 2022). To address this, it is essential to understand the barriers individuals face when trying to adopt this dietary pattern. Qualitative studies have identified several obstacles (Tsofliou, 2022):
- Availability and Accessibility of Foods: Some people struggle to find the necessary foods for the Mediterranean diet.
- Cognitive Factors: Lack of awareness about the health benefits and uncertainty about how to incorporate recommended foods can hinder adherence.
- Demographic Factors: Lower education levels, socioeconomic status, and concerns about cost may discourage adherence, especially among younger people and males.
- Financial Constraints: High food insecurity and lower income levels can make it challenging to follow the diet.
- Lifestyle Factors: Sedentary behavior, smoking, medical issues, and higher body mass index (BMI) are associated with lower adherence.
- Motivational Aspects: The absence of strong motivation can hinder sustained adherence.
- Sensory Challenges: Disliking certain foods, difficulty chewing, reluctance to give up favorite foods, and poor appetite can all affect adherence.
- Sociocultural Factors: Lack of time or skills to prepare Mediterranean meals, family opposition, work-related stressors, and cultural differences may play a role.
By addressing these barriers, we can develop strategies to promote better adoption of the Mediterranean diet and improve overall health outcomes.
References
Bizzozero-Peroni, B., Brazo-Sayavera, J., Martínez-Vizcaíno, V., Fernández-Rodríguez, R., López-Gil, J. F., Díaz-Goñi, V., Cavero-Redondo, I., & Mesas, A. E. (2022). High Adherence to the Mediterranean Diet is Associated with Higher Physical Fitness in Adults: a Systematic Review and Meta-Analysis. Advances in Nutrition, 13(6), 2195–2206. https://doi.org/10.1093/advances/nmac104
Damigou, E., Faka, A., Kouvari, M., Anastasiou, C., Kosti, R. I., Chalkias, C., & Panagiotakos, D. (2023). Adherence to a Mediterranean type of diet in the world: a geographical analysis based on a systematic review of 57 studies with 1,125,560 participants. International Journal of Food Sciences and Nutrition, 74(8), 799–813. https://doi.org/10.1080/09637486.2023.2262781
Obeid, C. A., Gubbels, J. S., Jaalouk, D., Kremers, S. P. J., & Oenema, A. (2022). Adherence to the Mediterranean diet among adults in Mediterranean countries: A systematic literature review. European Journal of Nutrition, 61(7), 3327–3344. https://doi.org/10.1007/s00394-022-02885-0
Laffond, A., Rivera-Picón, C., Rodríguez-Muñoz, P. M., Juárez-Vela, R., Ruiz de Viñaspre-Hernández, R., Navas-Echazarreta, N., & Sánchez-González, J. L. (2023). Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review. Nutrients, 15(15), 3356. https://doi.org/10.3390/nu15153356
Tsofliou, F., Vlachos, D., Hughes, C., & Appleton, K. M. (2022). Barriers and Facilitators Associated with the Adoption of and Adherence to a Mediterranean Style Diet in Adults: A Systematic Review of Published Observational and Qualitative Studies. Nutrients, 14(20), 4314. https://doi.org/10.3390/nu14204314
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